Adult Medicaid Manual MA-2525 DISABILITY

I. INTRODUCTION

Individuals under age 65 may be eligible for Medicaid if they are disabled according to the Social Security definition of disability. The aid program/category is MAD (Medicaid Aid to the Disabled).

Under Title II and Title XVI of the Social Security Act, disability is defined as the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment or combination of impairments that is expected to result in death or which has lasted or is expected to last for a continuous period of not less than 12 months.

The working disabled may be eligible for Medicaid under the Health Coverage for Workers with Disabilities Program (HCWD). See MA-2180, Health Coverage for Workers with Disabilities. To be eligible under this program, the individual must meet the Social Security definition of disability except for the substantial gainful activity requirement.

Individuals who receive Social Security (RSDI) or Supplemental Security Income (SSI) because they are disabled are considered to meet the disability requirement for Medicaid. All other individuals who apply for MAD must have a determination of disability (refer to V.D. below for exceptions). In addition, if an RSDI/SSI beneficiary requests MAD coverage for a period prior to the disability onset date established by Social Security, he must have a disability determination for that period of time.

North Carolina Disability Determination Services (DDS) determines disability for North Carolina residents who apply for RSDI, SSI and Medicaid.

This section provides instructions on whether a disability determination is required and how to request it, processing Medicaid cases reopened due to appeal reversals or Social Security approvals, reacting to changes in disability status, protected status for children and periodic reviews of disability.

A. SSI Beneficiaries

A person under age 65 who receives SSI disability is automatically eligible for Medicaid as MAD without a separate application or a disability determination. If the SSI beneficiary requests Medicaid for a period prior to his authorization for SSI, he must apply for MAD for that period and be determined disabled. Refer to MA-1000, SSI Medicaid - Automated Process and to MA-1100, SSI Medicaid - County Responsibility and to IV. below.

REVISED 11/01/08 - CHANGE NO. 24-08

(I.)

B. Social Security Disability Beneficiaries (RSDI)

A person who receives Social Security based on disability meets the disability requirement for Medicaid. However, he is not automatically eligible for Medicaid. He must apply for Medicaid and must meet all other eligibility requirements. If the Social Security disability beneficiary requests Medicaid for a period prior to his onset date for disability, he must apply for that period and be determined disabled.

C. Persons Not Receiving Social Security Disability or SSI

A person who wishes to apply for Medicaid based on disability and who is not receiving Social Security Disability or SSI must be determined disabled by DDS (Refer to V.D. below for exceptions).